TAVR may be better than surgery for patients with obesity, severe aortic stenosis
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Key takeaways:
- In patients with severe aortic stenosis and obesity, TAVR conferred lower rates of in-hospital mortality and other outcomes vs. surgery.
- TAVR was linked to greater need for pacemaker implantation.
In patients with severe aortic stenosis and obesity, transcatheter aortic valve replacement was associated with better rates of in-hospital mortality and other outcomes compared with surgery, according to a meta-analysis.
“Obesity, defined as body mass index 30 kg/m2 , is very prevalent in patients who are being referred for treatment of severe aortic stenosis, and recent data has estimated that 13% to 17% of patients referred to TAVR are obese,” Khalid Saeed Al-Asad, MD, internal medicine resident at Michigan State University, and colleagues wrote. “Evidence supporting the safety of TAVR in obese patients, however, is limited and the best therapeutic approach in this patient population remains debatable.”
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Al-Asad and colleagues conducted a meta-analysis of three registry-based studies and one retrospective multicenter study consisting of 37,743 patients with obesity and severe aortic stenosis, of whom 8,353 underwent TAVR and the rest underwent surgical AVR.
Those who had TAVR were older (77 years vs. 67 years) and were more likely to be women (58% vs. 44%) compared with those who had surgical AVR, the researchers wrote.
The primary outcome of in-hospital mortality was lower in the TAVR group (OR = 0.64; 95% CI, 0.42-0.96; P = .04; I2 = 64%), Al-Asad and colleagues wrote.
In addition, compared with the surgery group, the TAVR group was less likely to have acute kidney injury (OR = 0.54; 95% CI, 0.39-0.85; P = .0002; I2 = 85%), postoperative sepsis (OR = 0.33; 95% CI, 0.18-0.59; P = .0002; I2 = 0%) and blood transfusion (OR = 0.27; 95% CI, 0.15-0.49; P < .0001; I2 = 89%), according to the researchers.
However, consistent with previous studies of TAVR vs. surgical AVR, the TAVR group was more likely to need a pacemaker implanted permanently (OR = 2.43; 95% CI, 1.87-3.15; P < .00001; I2 = 70%).
There was no difference between the groups in MI (OR = 0.76; 95% CI, 0.34-1.67; P = .49; I2 = 88%), the researchers wrote.
“Our analysis provides evidence that supports the feasibility and safety of TAVR in patients with obesity,” Al-Asad and colleagues wrote. “It also shows that TAVR is associated with a higher incidence of permanent pacemaker placement. This is consistent with recently published data and warrants caution when selecting the best therapeutic intervention for this group of patients. The transfemoral approach, which has been traditionally utilized for TAVR, could theoretically present a challenge in this patient population and might warrant the use of alternative access including transradial, transcaval, transapical or transcarotid. More studies, specifically randomized trials, with long-term follow-up and supplementary analyses of the different categories of obesity, are warranted to further assess the efficacy and safety of TAVR in this group of patients.”
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